Hannah Brinkman talks Substance Use and Heart Rate Variability

August 22, 2024 00:39:15
Hannah Brinkman talks Substance Use and Heart Rate Variability
Heart Rate Variability Podcast
Hannah Brinkman talks Substance Use and Heart Rate Variability

Aug 22 2024 | 00:39:15

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Show Notes

In this episode, Hannah Brinkman joins Matt to discuss her research and clinical work with substance use and heart rate variability biofeedback. 

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Episode Transcript

[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us [email protected] please enjoy the show. [00:00:32] Speaker B: Welcome Chris the Heart Rate Variability podcast. I'm Matt Bennett. I am here today with one of the great students doing some really exciting research in HRV, Hannah Brinkman. Hannah, welcome to the show. I really appreciate you being on there. Just been some. Recently, one of my goals has been to get more and more students on the show because I really think you all what I found are pushing the envelope and thinking around heart rate variability. This next generation coming up is just, I think, so much energy around this that I'm so excited to talk about you, your interest in research around HRV. And I know we're going to get into substance use and the autonomic nervous system as well. So I'm excited to have you on the show. So before we dive into your interest and expertise, just a quick introduction. Who is Hannah? [00:01:29] Speaker C: Yeah, so thank you and very happy to be here. So I am going into my 6th year of the clinical psychology PhD program at Rutgers. And so my work primarily looks at the bi directional relationship between stress and substance use, how it affects the brain, the body, and how disruptions in the system can increase risk for more substance use, but then also mental and physical health challenges, too. [00:02:02] Speaker B: Awesome. So this is something that's been a real interest of mine and in some ways, watching my work in homelessness, mental health, trauma, I've just seen the devastating impact of you throw substance use on top of complex trauma, PTSD, and it's just, it's just a recipe for real pain and suffering for folks. So I'm really interested, having kind of put my foot into this area somewhat significantly over the years. I'd love to see kind of what drew you into this research. And I sort of, you know, what sort of drives your interest in this subject. [00:02:49] Speaker C: I mean, I think you hit the nail on the head in that there's such a high comorbidity between substance use, but then also a lot of other mental health challenges that then just sort of span out into other aspects of social health problems, too, and public health issues. So for me, going a little bit back, I did my undergraduate study at the University of Massachusetts, Amherst, and that was sort of my first exposure to research, but it wasn't in the context of a psychology setting. It was actually in a sociology lab. And I was helping a professor of mine looking at the effects of the Chicago Housing Authority project. They sort of revamped the one of the living areas. And my professor was really interested in trying to understand how that demolition and reconstruction was influencing individual quality of life of residents that were there, but then also crime rates more broadly in the area. One of the tasks that I was helping her with was transcribing interviews that she had done with some of the residents there to hear more about their experience. And as I was transcribing and listening to these interviews, I was just really struck by how the just amount of stress and both acute stressors, you know, shootings or crime events that were happening in their neighborhood, and then also chronic stressors, too, like managing health conditions, rent, all that kind of stuff, influenced not only just their mental health, but also their physical health. And I was just really curious how that potentially influenced more problematic health behaviors like substance use. So that was sort of the sparkling of interest from there. And I knew that I wanted to go into psychology. I was really interested in research from there. So I pursued two employment experiences after my undergrad. The first was at Fordham University, where I was helping to run a clinical trial that was looking at the use of a smartphone based, mindfulness based intervention for people who smoke, but then also had co occurring mood disorders, so things like major depressive disorder, and seeing how the use of this mindfulness app could serve as an additional tool to help them quit smoking. And so I worked on that project for a little bit before shifting to my next place of employment, which was at Mount Sinai, where I worked in their trauma and resilience program. And there I helped to coordinate another clinical trial that was looking at the use of a Internet based psychotherapy study for rescue and recovery workers and then survivors who had persistent post traumatic stress symptoms from their involvement in the 911 attacks. So, kind of the collection of experiences that I had just really deepened my interest in trying to understand how stressors influence substance use and kind of vice versa. And then that led me to my current place at Rutgers, where I work in a lab that sort of really allows me to dive deeply into understanding sort of that bi directional relationship, but more so being able to understand how psychophysiological tools can help us to understand, okay, what are these effects that are happening at the level of the body? So things like heart rate variability, blood pressure, and how that increases risk for anxiety and stress related conditions. [00:07:03] Speaker B: Man, that's such a great story. I worked in the arena. It was sort of the south side of Chicago early in my career in northern Indiana. So I imagine like capernaum Green and other, I know there's been a lot of chaos obviously, on the south side of Chicago in recent years with the spikes and I shootings and all that as we really disrupted some of these, you know, historically established living environments. So fascinating. Fascinating, you know, connection and tragic in so many ways, working with that population as well. I'm curious, did heart rate variability find you, did you find heart rate variability, like, because it doesn't sound like that may have been something you were originally kind of focused on. So when did HRV come in on your radar? [00:07:59] Speaker C: Yeah, it's a great question because going into graduate school, I had no past experience with any type of HRV or anything like that. But my mentor and advisor, Doctor Teresa Lero, who I work with now, her lab had a really heavy focus on using psychophysiology and those kind of tools to study what's going on with substance use and then also anxiety and stress. So that was sort of my first introduction to it. And I just became so incredibly fascinated with not only the tools that can be used, but I just, I felt like it really, like, personally, for me, I'm really interested in understanding how, like, our are these systems that help us manage stress have evolutionarily, like, they're really adaptive in nature. Like, it's good to have a stress response when the environment demands it, and we also want to be able to recover from it, too. So I just became really, really fascinated with how these tools could really help us to understand these inherently adaptive systems and how substance use influences them. [00:09:15] Speaker B: Will and I would love, I want to ask this question the right way, but, like, substance use as an adaptive tool is something I've, I've really thought a lot about in my way. Sometimes we call it self medicating. I don't think anybody intentionally goes into substance use to, you know, develop an addiction over time. That's nobody's, nobody's goal. So I'm kind of, I'm curious as somebody who's like, oh, opiate receptors. And like, you know, my layman's summary of my research into this area, which is no win as intensive yours is like, nearly the whole biology eventually evolves around the use of the substance and mind body, neuron connections, receptors, all seem to be structured around use. And if you don't use, there are such negative consequences there for you and your system. So I'm wondering, as you look at sort of how addiction kind of forms from stressors and trauma and all these different things, how do you kind of conceptualize that? And you can speculate a little bit outside your concrete research, too, but how do you see addiction and stress and all this kind of come about for somebody? [00:10:48] Speaker C: So, as a part of my work, I do a lot of assessments, and they're like, structured tools that are sort of, like, gold standards for it. And my approach, when I sort of am thinking about some of substance use and whether it's just kind of, like, normal or if it's falling into a realm that's not really working for them, I always like to kind of consider sort of like, three factors. So the first is frequency. So how frequently are they using a substance? You know, in an average week, is it just like one day a week, or is it multiple days a week or daily? The second is quantity. So how much are they consuming on the days that they are using? Because someone who's maybe just having one drink could be having really different relationship with maybe alcohol or some type of substance than someone who is using or consuming maybe, like, five drinks. So frequency, quantity, and then context. So is it that you're kind of doing it socially alone, and, you know, one is not necessarily better than the other, just gives you sort of another data point to think about? And then the last one, and I think this kind of taps into your question about, like, how we sort of conceptualize substance use and stress is, like, what is the function of the use in a specific context? Is someone just, you know, having a drink because they want to reward themselves for, you know, doing a job well done, or they had been working really hard and they were on vacation, and they're like, wow, I really want to have a drink and just enjoy? Or is it because they're experiencing some really negative emotions and they can't kind of manage it and they're trying to avoid experiencing those? So those are usually kind of the four things that I usually try to take into account amongst others. [00:12:48] Speaker B: Yeah. And as you start to look at the physiological impacts on this heart rate variability and the other biometrics you measure, I'm just curious, with your research, you know, does this. Is this part of the assessment, like, how does this sort of inform the research that you're doing, but also just, it sounds like the general philosophy of, you know, the lab and the group that you're working with. [00:13:15] Speaker C: Yeah. So I guess more from, like, a psychophysics standpoint for me. So my lab, and for myself in particular, we're primarily in the realm of like nicotine and tobacco use. So take that sort of with like a grain of salt and let me just make sure I'm also getting your question. Aka, you're sort of asking, when does. [00:13:37] Speaker B: The physiological aspects like heart rate variability come into play? I don't know if that's part of the assessment you do with folks or, you know, just kind of how that works into the research that you all do. [00:13:51] Speaker C: Yeah, got it. So I can give you like one example. So one clinical study that was done by our lab was looking at the use of a heart rate variability biofeedback intervention to help people who are trying to quit smoking quit. So the HRVV component, which I've watched some of your previous episodes, it sounds like folks will probably be fairly familiar with what HRVB is. [00:14:23] Speaker B: Yes, I would imagine so, yeah. [00:14:26] Speaker C: So using this kind of breathing technique to really kind of stimulate and strengthen aspects of our cardiorespiratory system that can help us persist towards goals. So in the context of someone who is trying to quit, they can experience a lot of challenges, whether that's like difficult bodily sensations as they're going through withdrawal or difficult emotional states. So the use of HRVB was sort of being used as an additional tool in combination with traditional smoking cessation counseling to try and support people in making their quit attempt, in addition to using kind of like a nicotine replacement therapy as well. [00:15:13] Speaker B: Gotcha. Are you able to talk about any of the findings of sort of some of this work that you've been doing? I'd be curious to what are you all finding in integrating HRV biofeedback into some of these traditional approaches? [00:15:32] Speaker C: Yeah, so for that specific study, it was really more so looking at kind of like the feasibility and acceptability of the intervention for people. So it was a smaller study. I would say there were about like 28 people that ended up being enrolled. And overall, the findings showed that the intervention was fairly feasible. So it felt pretty usable and doable to people, and it could be integrated into their daily routine fairly easily in terms of helping them quit smoking on quick day. It did show that there were significant reductions in people's use, and I believe that that lasted about two weeks follow up and even like a month follow up. But then we also had folks come in for a three month follow up and that sort of significant effect sort of dropped off. So, you know, again, it's sort of something that we sort of take into account, you know, keeping in mind that wasn't against a control intervention. Small study, but I think it was really useful in terms of just kind of thinking about, okay, how can we use this tool that we know has a lot of clinical and health improvements and integrate it into other treatments to make it sort of like a more holistic approach? [00:16:56] Speaker B: Yeah, and you mentioned the role of stress in this equation. One of my initial teachers on this topic was Doctor Gabriel mate. The realm of hungry Ghost, if you're interested in the brain and addiction, is what I highly recommend. But he really, like, put into words what I had seen in my career, is for an addiction to take hold, you really need an organic body that's susceptible to addiction. That's basically a human being, maybe some genetic predisposition there, but I think that's always epigenetics versus genetics and all that. But you just need a body that can be, become addicted. You need a substance or behavior that can be addictive. And then what just blew my mind but made so much sense with stress like that was his third. Along with having a body along with the substance, that for addiction to take hold, you also need some sort of stressor or trauma present. That in many ways, I think, and I, and I'll give you the, the umbrella of being a little speculative if the research isn't there yet with it. But it's like, in many ways, when substance use becomes a coping skill, that's where things seem to get pretty dangerous, so someone might use it. And I always joke around is we have this thing in the United States at least called happy hour, which is a really well marketed way to use drugs after work to feel better. There's a drug dealer just right down the street from me called my bartender, and I have a hard day at work. My drug dealer down the street will give me two for one beers, and I start to feel better very quickly. In the short term, though, if I keep you, if that becomes my coping skill, which society kind of sets it up to do really well, then that could become dangerous. And I just kind of wondered what you have, you know, again, maybe you're in between the lines of what you've seen in some of the assessments you do. Maybe you actually have gotten the data about how, how stress really plays in from substance use that may bring, you know, substances make us feel good to becoming a problem for the individual in the form of an addiction. [00:19:21] Speaker C: Yeah, I mean, one way I think I can definitely take hold is that, you know, a lot of research, specifically of people who smoke cigarettes for a lot of people stress or some type of stressor is usually cited as one of the leading things that if they're in the attempt of trying to quit or stop their use, that will relapse them into returning back to their use. So I definitely think you're right on the market in that sense of, and I think what's really kind of challenging about that is, like, when we have this really acute stressor, you're, you know, by returning back to our use, we're sort of cheating ourselves from the opportunity to engage in new learning that, hey, you know, like, maybe I can actually tolerate this. Yes, it'll be very, very uncomfortable, but maybe I can actually tolerate this without using. And or, you know, maybe I can also find other coping mechanisms that could serve me better, not just in the short term, but actually in the long term. [00:20:35] Speaker B: Just blown away by the piece of learning that you just said was incredibly powerful. Like, you're missing that opportunity to develop, to learn from the experience you're facing. I think that, wow, I had, like, well, well done that, like, it just resonates with me so much because it's such an easy coping skill, and I have a lot of empathy for folks that, you know, hey, now, like, hey, I practice 25 minutes of HRV biofeedback every day, and I'm a better person because of it. But after a hard day, it's a so much easier to have a couple shots of whiskey more. Being in Colorado, just get a gummy and you're like, oh, you feel better right away. It's such an easy, available coping skill that I think a lot of people would probably think differently when they hear you talk about, there may be a mischance to learn from that experience, and that is incredibly powerful way. So what you do learn, I guess, would be, hey, if I have these couple shots or I have a bottle of wine for dinner, I feel better and that again. But you're escaping more than you are kind of dealing with that. And for a lot of people, that can get very dangerous clinically. [00:22:02] Speaker C: When I, you know, part of my training, I also do clinical work. And so whenever I'm working with someone who's maybe trying to manage their alcohol use or some other type of something, that's usually kind of the spirit that I like to go about it. You know, this is a fantastic opportunity for us to learn new ways of being. And, you know, a big thing in a lot of substance use treatment is sort of differentiating between this idea of a lapse versus a relapse. So a lapse is this idea that, okay, like, let's say, you know, we planned ahead, but, you know, this unexpected stressor came out of the blue, really threw us off our game, and we ended up reaching for a drink, and one drink turned to two. So what we would then do is sort of say, okay, you know, lapse is sort of like a bump in the road, and we can pull over to the side, check the car, make sure that the hubcap didn't fall off, and we can, you know, regroup and get back on the road and keep on driving. We don't have to turn all the way back. [00:23:13] Speaker B: That. I love that because relapse, you know, and I'm older now, so, like, I was back in the day. Like, my undergrad intern was in a residential substance use treatment, and, like, you had to be sober in order to get treatment, which I don't know why that made sense to anybody back in the day, but it was kind of like the mentality, the, you know, the real. You know, there's a lot of benefit to the twelve steps. So I'm not demeaning, but it was kind of like, you've got to stop using before you can started healing. And, you know, we just traumatized relapse so much that we probably led people to feel shame or just to relive all the positives of that experience. Um, because a lot of times what I saw, too, is folks that may have not have gotten over some of those humps, I kind of chuckled to myself when you said they had two beers, because when my folks relapsed, they may have had two bottles of Jack Daniel. Like, it was not. Like, all of a sudden, the weekend is. There's three or four empty bottles of whiskey sitting on the floor. I would dream of a two beer relapse or lapse. I like that terminology. But what I missed in all of that with my training was the fact that they had maybe a week or two of sobriety leading up to that. We never focused on that side of things. And that's where I thought we really, in hindsight, really screwed up. Like, we were screwing up a lot of things back then, but it was just like, yeah, I like the idea of a lapse, even if it may be more than maybe it's all set up all night, bender. But, hey, you're still alive. Would you learn from it? And again, maybe celebrate, whether it's a day of sobriety ahead of that or a week also, celebrating the effort was something we never did back in the day. So I love that way of thinking. [00:25:05] Speaker C: Absolutely. [00:25:06] Speaker B: So I'm curious as you, you know, maybe more with your clinical hat on with, with recovery. So, you know, somebody trying to, whether it's a harm reduction of cutting back on use or, you know, trying to establish full sobriety, you know, I'm curious about, you know, with your now knowledge about HRV, HRV, biofeedback, probably, I'm sure some other kind of meditation or mindfulness, you know, research that's mixed in there. How do you see some of these maybe technological things like biofeedback playing into people's recovery and kind of starting to get some control over for a lot of people, what they may not feel they have much power or control over. [00:26:01] Speaker C: I think one thing that's so beautiful, especially with, like, HRV bees, like, it's just you always have your breath. It's so portable. Your breath is always with you. And, like, how beautiful is that, that you are able to harness and leverage something within yourself to support you? And so I think the portability of it. And increasingly, I think more and more researchers are trying to figure out, okay, how can we develop tools and technology that can reduce previous barriers from people being able to learn these techniques. So I think wearable devices could be huge. Huge. And I think there's already a lot of research that's probably already starting down the road with that. But I think that that's one way that can really help to accelerate that and support people in recovery as well. [00:27:04] Speaker B: I love that. So I'm curious, just kind of a more philosophical question here, but as someone, and you got this a lot earlier in your career than I did when I started to become hear about heart rate variability and polyvagal theory and all this really amazing stuff with the autonomic nervous system coming into play, I wonder, as you've kind of evolved professionally and as a student and now you're doing research around biometrics and heart rate variability at a high level, I just curious how learning about this has kind of changed your kind of look at humans, whether that's clinically, whether that's yourself, just kind of as your perception of humanity, which you get in your fields. That's what we study. How has this kind of informed or changed how you look at humans in the human condition, really, in general, on a philosophical level? Just a small question for you. [00:28:21] Speaker C: Yeah, sure, no problem. I mean, I guess I can kind of start by thinking about it from, like. Like a clinical standpoint. So, like, if I'm working with someone and they come into a session and they are just really distressed and overwhelmed for me to try and jump in and, like, teach them skills, it's just not going to be effective if they don't have the cognitive resources to really access that. So I think since working in a realm that has taught me so much the importance of using the body to help regulate ourselves to better access those resources, I think it helps me to learn how to be more effective in maybe the structuring of a session that I'm having with someone. And then similarly for myself, if I'm going into a situation and maybe I'm feeling anxious or nervous, just the utility of being able to breathe, do some exercises, and sort of regulate my physiology a little bit just to sort of help ground me. So I have a little bit more room up here to respond more flexibly. [00:29:32] Speaker B: So where do you think, as you look, I imagine you're probably into your dissertation at this point. Like, where is Hannah going with heart rate variability? Like, where do you see it? You know, kind of as you look out, I love to know what your next steps are. And however, if you're just getting through your dissertation, I give you full permission to say really thought anywhere past that at this point. But kind of where do you see your career going? Where do you see maybe HRV being a part of some of your next steps as your career continues to move forward? [00:30:15] Speaker C: Yeah, so it's a great question. I am currently doing my dissertation study, which is actually funded by the National Institute on Drug Abuse. [00:30:26] Speaker B: Congratulations. [00:30:27] Speaker C: Thank you. Yeah, it's a training grant, and it actually has a very big focus on understanding these sort of, like, physiological mechanisms between substance use and anxiety. So with this grant, I'm not only able to, you know, look at HRV, which we typically kind of conceptualize as sort of like a top down metric, but I'm also able to expand my knowledge and understanding of something called the barrow reflex as well, which is sort of this kind of physiological mechanism that helps to facilitate the bidirectional communication between the brain and the body. So, to answer your question, I would really love to be able to go into a realm where I'm able to take this knowledge of these physiological processes and apply that in a realm whether it be more clinically oriented or research oriented, but really helping to inform holistic interventions that can sort of take the knowledge that we know about when we use nicotine, alcohol, how is it affecting the body? And then what are interventions that we can design that make sure that we're factoring in that component when we treat people? [00:31:51] Speaker B: I love that. And I hope this question, if it's too personal, you can just tell me to shut up. But I, you know, there's a lot of energy in the HRV arena right now. But it also, like, one of my favorite daily podcasts is the daily by the New York Times, which, you know, if the daily does an episode on something, it's kind of hit mainstream. And they recently did something. And I think for anybody who's measured their HRV, especially when you get my age, you start to see the, especially with alcohol. Like, the impact alcohol has on your HRV the next day is pretty devastating. Like, it's hard to escape those effects. So I just kind of wonder, as you look, like friend group socially, like, with your, you know, because I know, like, entering the substance use treatment realm for me really changed how I saw, like, especially in undergrad, you know, it was weird to go to a treatment center during the day and then hang out with my friends at night. It was like a whole different realm. So just kind of insights, like, as this movement sort of that alcohol isn't good for you. And maybe we should all think about, you know, this use. I just kind of wonder how all this data, when you maybe just talk to your friends about this, or you think about, like, you know, yourself, kind of how this kind of informs your thinking about drugs and alcohol. Just, just kind of in a more general way. [00:33:24] Speaker C: Think about it in the sense of like, okay, not only how is, like, me having a drink at this time point, like, happening in the night, but then what is its effect on subsequent health behavior? So what's my sleep going to be like that night? Probably not as great. How am I going to feel the next day? How does that then, you know, influence whether I'm going to be up and ready to go to the gym or maybe I'm more sedentary or maybe I'm vegging out of. So I think probably in doing this work, it just makes me think more broadly about how, you know, typically one sort of, you know, unhealthy behavior in moderation, of course, oftentimes travels with others. And it's sort of like that broader constellation that I think I'm. I'm more attuned to. [00:34:12] Speaker B: Yeah. And it's kind of fascinating to see. And I think, like, listening to other HRV podcasts, I mean, it just seems like HRV just destroys drinking for you. Like, it's like one, okay, one at maybe 01:00 p.m. with lunch. Maybe I'm not waking up with, with 20% lower scores. But for me, like, it just got to the point is, okay, one drink, and maybe I shouldn't drink double ipas. I could lean a little gentler, but, like, they're just there, so why not? I just couldn't take, like, the cost was quantified for me the next day, and it was just like, damn. Like, this thing that I could enjoy fairly safely, you know, maybe I just had to totally rethink, like, is it worth what the cost is the next day? And I'm glad I got that data, though. My friends make fun of me that I'm going to eliminate any fun behavior at some point, but they're tolerant. [00:35:13] Speaker C: So I think what you're really hitting on, though, is, like, the utility of, like, having this information and, like, the benefit that having tools that can give you information so you can make an informed decision whether or not you choose to do something. I think that more so taps into one's values. [00:35:30] Speaker B: Yeah. [00:35:30] Speaker C: And those are completely, you know, individualized. And they not only are different between people, but also within a person, too, over time. [00:35:38] Speaker B: Yeah, absolutely. And that that's a, you know, I claim the value of health and wellness, and obviously, I've got data to show that even one or two drinks goes against that. And then I think there's this interesting point you get to. And again, age isn't your friend, either with heart rate variability or drugs and alcohol. So, I mean, I'm dealing with that, too, but just kind of, you're confronted with the weird existential thing. Is, is my drug use worth the cost? Even if it's not necessarily, like, at the point of an addiction, like, is an alcohol is just for me. I wouldn't call it an allergy, but my HRV just says, this is not good for you, obviously. Like, I wouldn't do anything else that did that to my heart rate variability. Is this drug kind of worth it? And when you start to, like, look at it from an objective perspective, those questions don't sit incredibly comfortable with you in a way that if you're going to live your values and you try to be a role model for that sort of life, not really good for you. So I just think it's a fascinating point where we've gone to as a society of kind of confronting this that is so just accepted now there's, like, this really movement. Like I said, it hit the, I think, most popular podcast in the world is the daily. Like, they're talking about this, like, in a way that they're even. Like, there's this whole movement now of folks who don't drink anymore because of this. And it's. It's just a fascinating place to find ourselves in, so. [00:37:20] Speaker C: Totally. Especially because, like, when you're thinking about the, like, cultural components of it and everything like that, too. Definitely. [00:37:27] Speaker B: Yeah. Telling people you don't drink is really weird. Especially if they knew you when you did. And then to say, because of my heart rate variability, and they're like, well, what's that? [00:37:38] Speaker C: Opens another can of worms. [00:37:40] Speaker B: Here we go. Like, you drink your wine because you'll need it. Because I need at least 45 minutes to get my out here. Hannah, I really appreciate you coming on, and please keep us in mind for any future research you do. I am really fascinated with that. Next step as well is looking at the integration because this is where I think we're really with heart rate variability. And my obsession with optimal HRV is how do we integrate this in one an affordable way? So it's not that we don't develop another health inequity like with the populations you work with. They're not going to be afforded a dollar, $400, 500 watch or a. A membership with that. So, like. But how do we integrate this into more of a holistic approach? And I love how you think about this. So I would love for you to come back and keep sharing any additional research you have. But also, once you get that dissertation done, let's have a show on that and then follow your next step because I'm excited to see what your dissertation turns out and then where that leads you in your career. [00:38:56] Speaker C: Thank you. I look forward to it, too. [00:38:58] Speaker B: Awesome. Well, I'll put some information about Hannah in the show notes. As always, you can find optimal hrv.com dot. Hannah, thanks so much for joining us and sharing your research and your work. And I thank our audience, too. And as always, we'll see you next week.

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